The report, released on Tuesday in conjunction with the Ugandan government and several UN agencies, was compiled after consultations with IDP camp leaders, government and private health facilities, nongovernmental organisations (NGOs) and other HIV/AIDS service providers between September and December 2006. The aim was to map out existing HIV/AIDS services and identify gaps.
"Despite efforts made by the district authorities and service providers, there has been a lack of coordination and information regarding what HIV services are available in the north, and this report tries to pull all the information together," Angela St Jules, IOM project officer in the capital, Kampala, told IRIN/PlusNews.
For the past 20 years a brutal conflict between the rebel Lord's Resistance Army (LRA) and the government has driven over one million people in northern Uganda into camps across the region. HIV prevalence in north-central Uganda - Apac, Gulu, Kitgum, Lira and Pader districts - averages about 8.2 percent, compared to 6.4 percent nationally.
"Referral services are particularly weak, which is something we heard from both the IDPs and the service providers," St Jules said. "You find CBOs [community based organisations] and NGOs sometimes unsure of where to refer patients, as resources are limited and service providers may not have the capacity to respond. There is a real need to support local CBOs, because a lot of the response comes from them."
Annette Kobusingye, regional HIV advisor in the Gulu office of the international NGO, Save the Children, described coordination as "the missing link in HIV service provision".
"There is an HIV coordination body involving the government and NGOs at the district level, but it tends to depend on the availability of funds, so its efficiency fluctuates," she said. "We do have a system of referral, but you can refer someone to another agency for further assistance; whether they actually get there is another matter ... it needs to be more systematic."
The IOM report found that most people had to leave the camps and travel to hospitals or large health centres for HIV counselling and testing. In some cases, health facilities provided testing without counselling, a situation IOM described as "grave".
Service availability also varied between districts: some, such as Pader, had a single major health centre for the whole district; others, such as Gulu, were serviced by several hospitals.
Prevention of mother-to-child transmission (PMTCT) services were also limited to large health centres and hospitals, and many pregnant women living in the camps had to travel long distances for testing or treatment.
Save the Children's Kobusingye said lack of follow-up, particularly of PMTCT and treatment, was another major problem. "You can advise a woman, when she comes for her initial antenatal visit, that to prevent her child from contracting the virus she must come back to the health unit to deliver, but without follow-up many of them end up having their babies in the village."
She confirmed the finding of the IOM report that, despite the region's large numbers of HIV-infected children, paediatric HIV/AIDS services were few and far between.
"An extremely limited number of service providers indicated providing HIV/AIDS services for children, particularly in regards to testing and treatment," the report stated. According to the IDP leadership, only 37 percent of the 198 IDP locations had any special services for orphans and vulnerable children.
Condom distribution in the camps was found to be high but still not enough and, according to St Jules, although there was no shortage of HIV/AIDS information, there was a lack of "comprehensive education".
"For instance, faith-based organisations are not talking about condoms, and few organisations have started educating on the human rights of people living with HIV/AIDS," she said.
The report recommended the establishment of a systematic referral system at district level to improve the overall quality of HIV/AIDS service provision, along with better coordination among service providers to ensure a more even distribution of health services, and an improved flow of information between service providers and the IDPs.
Health workers said the need for a more coordinated HIV strategy in the region was more urgent than ever, and pointed out that if the ongoing peace talks between the LRA and the government succeeded, northern Uganda's IDPs would return to their homes and be scattered across the region, where they would be much harder to reach.
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